Provider Demographics
NPI:1669727772
Name:DIANE M. WALKER PSY. D. P.A.
Entity type:Organization
Organization Name:DIANE M. WALKER PSY. D. P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANE
Authorized Official - Middle Name:
Authorized Official - Last Name:CROWTHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-696-2233
Mailing Address - Street 1:6655 S US HIGHWAY 1
Mailing Address - Street 2:
Mailing Address - City:GRANT
Mailing Address - State:FL
Mailing Address - Zip Code:32949-2221
Mailing Address - Country:US
Mailing Address - Phone:321-696-3325
Mailing Address - Fax:
Practice Address - Street 1:6655 S US HIGHWAY 1
Practice Address - Street 2:
Practice Address - City:GRANT
Practice Address - State:FL
Practice Address - Zip Code:32949-2221
Practice Address - Country:US
Practice Address - Phone:321-693-3325
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-16
Last Update Date:2012-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY5049103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty